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Journal of Lipid Research, Vol. 45, 2339-2344, December 2004 Validation of deuterium-labeled fatty acids for the measurement of dietary fat oxidation during physical activity
* Interdepartmental Program in Nutritional Sciences, University of Wisconsin-Madison, Madison, WI Published, JLR Papers in Press, September 1, 2004. DOI 10.1194/jlr.M400289-JLR200
1 To whom correspondence should be addressed. e-mail: dschoell{at}nutrisci.wisc.edu
Measurement of 13C-labeled fatty acid oxidation is hindered by the need for acetate correction, measurement of the rate of CO2 production in a controlled environment, and frequent collection of breath samples. The use of deuterium-labeled fatty acids may overcome these limitations. Herein, d31-palmitate was validated against [1-13C]palmitate during exercise. Thirteen subjects with body mass index of 22.9 ± 3 kg/m2 and body fat of 19.6 ± 11% were subjected to 2 or 4 h of exercise at 25% maximum volume oxygen consumption (VO2max). The d31-palmitate and [1-13C] palmitate were given orally in a liquid meal at breakfast. The d3-acetate and [1-13C]acetate were given during another visit for acetate sequestration correction. Recovery of d31-palmitate in urine at 9 h after dose was compared with [1-13C] palmitate recovery in breath. Cumulative recovery of d31-palmitate was 10.6 ± 3% and that of [1-13C]palmitate was 5.6 ± 2%. The d3-acetate and [1-13C]acetate recoveries were 85 ± 4% and 54 ± 4%, respectively. When [1-13C]acetate recovery was used to correct 13C data, the average recovery differences were 0.4 ± 3%. Uncorrected d31-palmitate and acetate-corrected [1-13C]palmitate were well correlated (y = 0.96x + 0; P < 0.0001) when used to measure fatty acid oxidation during exercise. Thus, d31-palmitate can be used in outpatient settings as it eliminates the need for acetate correction and frequent sampling.
Supplementary key words substrate utilization mass spectrometry stable isotopes
Stable isotopes have been used to quantify plasma and dietary fat oxidation in the past (13). When a 13C-labeled fatty acid is dosed orally or by constant infusion, the 13CO2 in breath can be used to measure the tracer oxidized. The 13C liberated during oxidative metabolism, however, is partly sequestered in the intermediates of the tricarboxylic acid (TCA) cycle ( 40%) and the bicarbonate pool (10%), causing fat oxidation to be underestimated. To correct for this sequestration, an additional dose of [1-13C]acetate is administered. Acetate is converted to acetyl-CoA and is oxidized in the TCA cycle (4). Unfortunately, sequestration is variable and depends on the conditions under which it is measured; hence, estimation of acetate sequestration is essential (5). In addition, the use of 13C-labeled fatty acid is further constrained by the need for frequent sampling of breath and the use of a metabolic cart or respiratory chamber to quantify the flux of CO2 to calculate 13C recovery accurately. These factors increase subject burden; thus, an alternative method to quantify fat oxidation in the body would be useful. One such method for the measurement of fat oxidation is the use of deuterium-labeled fatty acids (3, 6). When oxidized, 2H-labeled fatty acid is metabolized to acetyl-CoA, releasing NADH molecules. The 2H label is released as water, in part, when NADH molecules are oxidized in the respiratory chain. Oxidation of acetyl-CoA in the TCA cycle releases the rest of the deuterium label in the form of 2H-labeled water. This 2H2O mixes with the body water and can be sampled in the urine (7). Urinary and insensible water losses are minimal (8); hence, the enrichment of label in urine can be used effectively to calculate the cumulative recovery of the label and hence the fat oxidized. Consequently, the need for measurement of CO2 and flux is also eliminated. Deuterium-labeled palmitic acid has been validated against acetate-corrected 13C-labeled palmitic acid during rest in humans by Votruba, Zeddun, and Schoeller (6), who dosed subjects at rest with 13C- and d31-labeled palmitic acid and demonstrated that the cumulative recoveries for both tracers were highly correlated (y = 1.045x 0.47; r 2 = 0.88; P < 0.0002). More importantly, the mean difference in percentage recovery of the labels was 0.5 ± 2.8% when 13C data were corrected for acetate fixation. This method raises interesting possibilities for use under free-living conditions; however, this method has not been validated under nonresting conditions. Herein, we compared the metabolic fate of orally ingested d31-palmitate and [1-13C] palmitate during physical exercise of varying durations at moderate intensity. The objective was to ensure the validity of 2H-labeled fatty acids as an accurate tool to measure dietary fat oxidation under a range of free-living conditions.
Materials Labeled fatty acids were obtained from Cambridge Isotope Laboratories (Andover, MA). [1-13C]palmitic acid and Na salt of [1-13C]acetate were 99 atom% 13C. The d31-palmitic acid was 98 atom%, and Na salt of d3-acetate was 99 atom% 2H. The 18O was obtained as water (Isotec, Inc., Miamisburg, OH) and was 10.8 atom%.
Subjects
Protocol The study included two visits 34 weeks apart. The protocol for both visits was similar for a given subject except for the tracers given. The subject reported to the General Clinical Research Center GCRC at 6:00 PM on the evening before the test. During this day, the subjects were allowed to engage in normal daily activities, with the exception of any vigorous activities or structured exercise. At 7:00 PM, they were asked to void, and a urine sample was stored to determine the basal body enrichment in H218O. After being weighed, a 0.4 g/kg estimated total body water dose of 10% H218O was given to the subjects. Dinner (a standard meal) was provided at 6:00 PM. At 11:00 AM, another urine sample was collected for the determination of the total body water through H218O enrichment of bodily fluids at isotopic equilibration, achieved 4 h after dose. The 24 h energy requirements of the subjects were calculated from the World Health Organization (WHO) equation (10) and were divided into 40% at dinner, 30% at breakfast, and 30% at lunch. An activity factor of 1.5 for the previous day and 1.7 for the test day were added to the WHO calculated energy expenditure. The macronutrient distribution of each standard meal consisted of 50% carbohydrates, 35% fat, and 15% protein. On the day of the test, subjects were awakened at 6:30 AM, and a urine sample was collected at 6:45 AM. Urine and breath samples were collected at 8:00 AM to measure the natural abundance of 2H in the body water and the natural 13CO2 abundance in breath, respectively. The first visit consisted of an oral load of [1-13C]acetate at 2 mg/kg body weight and d3-acetate at 10 mg/kg body weight mixed in a liquid replacement meal (Boost high protein; Mead Johnson Nutritionals) during breakfast. The second stay consisted of an oral load of [1-13C]palmitate at 10 mg/kg body weight and d31-palmitate at 15 mg/kg body weight, mixed in the same liquid replacement meal during breakfast. Subjects exercised at 10:00 AM for 2 h (2 hr-eEx) or 4 h at a light intensity (25% VO2max) on a cycle ergometer. Within the 4 h exercise group (n = 8), three subjects started exercise at 10:00 AM [45 min after dose; early exercise (4 hr-eEx)] and five subjects started exercise at 1:00 PM [3 h, 45 min after dose; late exercise (4 hr-lEx)]. Measurements of CO2 flux were taken for 20 min every hour. Respiratory gas exchange (RGE) was measured for 20 min every hour during the rest of the stay including at rest, during exercise, and after exercise using a Deltatrac I metabolic cart (Sensormedics). The O2 and CO2 analyzers were calibrated with a standard gas containing a 96% O2 and 4% CO2 mixture. The subjects breathed through a mouthpiece with their noses clipped to ensure complete respiratory gas monitoring. The valve is connected to a canopy system, which acts as a mixing chamber, and is exhausted into the Deltatrac system to measure the rate of oxygen consumption and carbon dioxide production. The first 5 min of measurement was excluded, and the hourly RGE was calculated assuming that the subsequent 15 min measurements per hour were representative of the whole hour. [1-13C]palmitate oxidation rates were calculated using hourly breath samples collected when subjects blew through straws into 15 ml additive-free VacutainersTM (BD, Franklin Lakes, NJ), and d31-palmitate oxidation rates were calculated from the spot urine samples collected every hour and stored in cryogenically stable tubes (Corning, Inc.). The recovery correction factor for [1-13C] palmitate and palmitate was determined using the [1-13C]acetate and d3-acetate recovery rates.
Sample analysis To measure the ratio of 2H to 1H in urine, a sample (5 ml) of urine was mixed with 200 mg of carbon black to reduce impurities and was passed through a 0.45 µm filter (11). One milliliter of decolorized urine was placed in a 3 ml autosampler vial and analyzed for 2H/1H ratios using the Delta plus IRMS (Finnigan MAT). A 0.8 µl aliquot was injected into a chromium-packed quartz tube held at 850°C to reduce water to hydrogen gas. Each sample was injected three times with independent analysis. Data were corrected for H3+ and memory errors. Results were corrected to the standard mean ocean water (SMOW) scale. Total body water was estimated from 18O enrichments in urine samples collected at baseline and 4 h after dosing with 18O-labeled water. One milliliter of decolorized urine sample was allowed to equilibrate with CO2 at 25°C for 48 h in a water bath. The 18O enrichment was measured using a continuous-flow IRMS as detailed by Schoeller and Luke (12). Total body water was calculated from the 18O data using the dilution method as described by Schoeller and van Santen (8).
Label calculations
where VCO2 is measured in milliliters per minute; RSTD = 13C/12C of standard CO2; D = dose in grams; P = 13C isotope atom%; n = number of labeled atoms per molecule of tracer; MW = molecular weight of the tracer ([1-13C]acetate Na salt = 83; [1-13C]palmitic acid = 257); and isotopic enrichment above the baseline (Del) per mille ( Breath samples were collected for 9 h after dose on both visits to correct for hourly acetate sequestration of acetate label in the TCA cycle. Deuterium recovery was calculated assuming that it is equally distributed across the total body water (TBW). where TBW (moles) is multiplied by a factor of 1.035 to get a 2H dilution space from the TBW obtained by 18O dilution space; RSTD = 2H/1H of SMOW; D = dose in grams; P = 2H isotope atom%; n = number of labeled atoms per molecule of tracer; MW = molecular weight of the tracer (d3-acetate Na salt = 83; d31-palmitic acid = 287). The hours after dose represents the midpoint between voids for 2H recovery calculations. Because the mean difference in body weight between visits was 0.39 ± 1.3 kg, the TBW in these subjects was assumed to be constant.
Statistical analysis
ANOVAs of the ratios of [1-13C]palmitate to d31-palmitate recoveries did not show a significant difference between exercise groups (mean difference = 0.03%; P = 0.9). Hence, exercise groups were combined for this analysis.
Acetate recovery
Palmitate recovery Instantaneous 13CO2 recovery from [1-13C]palmitate oxidation peaked at 4.25 h after dose in the 4 hr-eEx group and at 6 h after dose in the 2 hr-eEx and 4 hr-lEx groups. Cumulative [1-13C]palmitate recovery at 3, 6, and 9 h after dose was 0.6 ± 1%, 2.9 ± 1%, and 5.6 ± 2% (Fig. 2) , respectively, without acetate correction. When [1-13C]palmitate recovery was corrected for sequestration using average group acetate recovery correction factor, the mean 3, 6, and 9 h postdose recoveries were 1.1 ± 1%, 5.7 ± 3%, and 10.7 ± 4%, respectively. Corrected [1-13C]palmitate using each individual subject's acetate recovery was 1.3 ± 1%, 5.7 ± 3%, and 10 ± 3% at 3, 6, and 9 h after dose (Table 3).
2H2O recovery from d31-palmitate oxidation peaked at 3.4 h after dose in all exercise groups alike. The d31-palmitate recovery 3, 6, and 9 h after dose was 1.5 ± 1%, 7.3 ± 3%, and 10.6 ± 3%, respectively. To correct for loss of tracer in the TCA cycle, d31-palmitate recovery at each time point was divided by exercise group mean acetate recovery at the same time point. The 3, 6, and 9 h postdose d31-palmitate recovery was 1.7 ± 2%, 8.3 ± 4%, and 12.0 ± 4%, respectively (Table 3). These values are not significantly different from uncorrected d31-palmitate recoveries (mean difference = 1.76%; P = 0.55), indicating little need for acetate corrections when 2H-labeled fatty acids are used.
Validation
Votruba, Zeddun, and Schoeller (6) validated the use of d31-palmitate for the measurement of dietary fatty acid oxidation against [1-13C]palmitate under rest conditions. Mean cumulative recovery of [1-13C]acetate at 10 h after dose was 53.7 ± 10.4%. Mean cumulative [1-13C]palmitate recovery corrected for acetate sequestration at 10 h after dose was 12.9 ± 8.5% and that of d31-palmitate was 13.2 ± 7.7%. Acetate corrected 13C data correlated well with d31-palmitate recovery in these subjects at rest (r 2 = 0.88). These data, when combined with our data, showed a strong correlation (r 2 = 0.79) between [1-13C]palmitate recovery corrected for acetate recovery and d31-palmitate recovery, suggesting that 2H label can be used independent of acetate correction under conditions of rest and exercise alike (Fig. 4) . Also, the exercise subjects showed no significant difference in their label recoveries compared with the recoveries of subjects at rest reported by Votruba, Zeddun, and Schoeller (6) (P = 0.11).
The present study demonstrates the validity of deuterium-labeled fatty acids to measure the oxidation of dietary fatty acids during exercise, expanding on the previously validated rest condition. The 2H label not only offers an effective alternative to 13C labeling, it also has the advantage of eliminating the need for an acetate correction, because acetate hydrogen sequestration in the TCA is minimal. The needs for frequent sampling and VCO2 measurements are also eliminated by the use of 2H label; hence, it can be used under free-living conditions without hindering the subject's normal daily activities. Although this validation was performed using stable isotope-labeled fatty acids, radioisotope-labeled fatty acids have also been used to measure dietary fatty acid oxidation under rest and exercise conditions. Romanski, Nelson, and Jensen (13) dosed their subjects with [3H]triolein and [14C]triolein along with their meal to study the trafficking of dietary fat toward oxidation or storage for 24 h after dose. Although acetate corrections for both radioisotopes were not measured, the cumulative 3H and 14C recoveries were correlated; thus, our results should apply equally well to these radioisotopes. Carbon labeling of fatty acids appears as a natural choice for the measurement of oxidative processes, but it is subject to sequestration in the TCA, leading to reduced yield (14). Since Sidossis et al. (4) proposed the use of a correction factor for acetate sequestration in the TCA cycle intermediates, 13C-labeled fatty acids have been used for the measurement of substrate metabolism, including fatty acid oxidation rates, but their accuracy has been debated. Acetate exits the path of the labeled substrate metabolism before entry into the TCA cycle and hence can account for label sequestration occurring in the TCA cycle. The accuracy of correction for sequestration depends on the position of the label in the fatty acid and the physiological conditions under which its metabolism is measured (15).
Unlike labeled carbons, most of the 2H label from fatty acids is rapidly released as reducing power (NADH-H+ and FADH2) during ß-oxidation and then again in the TCA cycle (4). Thereafter, the 2H is oxidized to water and released into the total body water pool, which can be sampled in the urine. Because most of the NADH is formed during ß-oxidation, only Deuterium-labeled fatty acids when oxidized release the label in the body water pool, and sampling of urine measures the abundance of the isotope in the body water pool, whereas measurement of the abundance of 13CO2 in breath is an instantaneous measure of oxidation. Hence, administration of 2H label does not require the frequent measurement of VCO2 that is needed when using 13C label for the calculation of recovery. The use of hydrogen-labeled fatty acids virtually obviates the need for a controlled environment during the collection of a subject's samples. Moreover, because the tracer accumulates in body water, it reduces the potential error of missed peak oxidation with carbon labeling should the peak excretion occur between breath samples, a particularly troublesome issue with rapidly oxidized substrates such as acetate. The use of hydrogen labeling, however, requires the measurement of body water for recovery calculation, correction for water turnover for long recovery times, and is subject to dilution in the large body water pool. Correction of 2H fatty acid oxidation measures for acetate sequestration did not yield any significant difference against uncorrected data compared with group corrected 13C fatty acid oxidation. Because the coefficient of variation for d3-acetate recovery was only 5% between individuals of all exercise groups, correction using group acetate recovery versus individual recovery did not make a discernible difference in our data. This further emphasizes that deuterium-labeled fatty acids can be used to measure dietary fat oxidation without the need for measurement of acetate correction factor. In conclusion, we demonstrated that 2H-labeled fatty acids can be used to accurately measure the oxidation of dietary fat during exercise. Minimal sequestration of 2H label in the TCA eliminates the need for an acetate oxidation measure and hence an additional stay in the hospital. Also, compared with 13C label, 2H label can be used without the need for frequent sampling, VCO2 measurement, and restricted environment for measurements. Furthermore, high correlation between 13C-labeled fatty acids (corrected for acetate sequestration) and 2H-labeled fatty acids (uncorrected) suggests the accuracy of the measurement of fat oxidation using either method.
This study was supported by National Institute of Diabetes and Digestive and Kidney Diseases Grant DK-30031 and by General Clinical Research Center Grant RR03186. The authors thank the staff at the General Clinical Research Center for their help with inpatient stays and specimen collections. Manuscript received July 30, 2004 and in revised form August 26, 2004.
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